Long-term craniofacial morphology in young adults treated for a non-syndromal UCLP: A systematic review

Abstract

Minimizing mid-facial growth impairment is one of the treatment goals in cleft lip and palate surgery. As growth of the maxilla extends into young adulthood, long-term evaluation is essential to make a comprehensive assessment of a treatment protocol. There are numerous treatment approaches for cleft lip/palate surgery, and most have the characteristic distinction between either an early or a late cleft palate closure. PRISMA guidelines were applied to explore the quality of the current literature and to identify treatment factors influencing long-term cephalometric outcomes. The literature search was conducted in Pubmed, The Cochrane Library and Embase. We included studies evaluating cephalometric outcomes (SNA and ANB values on 2D cephalograms) in UCLP patients with a mean age of 16 years and older. Studies with an inadequate description of the timing of surgery were excluded. 17 studies comprising 906 patients were selected and included for critical appraisal. Treatment protocols differed considerably among the included studies and inconsistent methodology was common. Eight studies applied a one-stage procedure, 11 studies performed a two-stage reconstruction, and five studies made use of a vomer flap. Applying a multivariate model, we did not identify any treatment factors that significantly influenced growth (SNA/ANB values), except for the method of inclusion, suggesting the presence of significant selection bias within the studies. The current literature remains inadequate for evidence-based decision making and to advise parents if an early or late palate closure leads to a more favorable maxillary outgrowth. This manuscript will propose guidelines and recommended quality criteria for future studies.

Keywords: Adult; Cephalometry; Cleft lip; Cleft palate; Decision making; Maxilla.